OBJECTIVE - To evaluate the hospital care rendered to hyperglycemic in
dividuals who did not have a diagnosis of diabetes before admission. R
ESEARCH DESIGN AND METHODS - A total of 1,034 consecutively hospitaliz
ed adult patients at a 750-bed inner-city teaching hospital were evalu
ated. Patients with one or more plasma glucose values >200 mg/dl were
identified by the laboratory data system on a daily basis. Patients wi
thout a diagnosis of diabetes at the time of admission were evaluated
to determine if and how physicians addressed the hyperglycemia, whethe
r a new diagnosis of diabetes was made during admission, and whether f
ollow-up was planned to address the hyperglycemia. RESULTS - After exc
luding patients who were admitted for a primary diagnosis of diabetes,
37.5% of all hyperglycemic medical patients and 33% of hyperglycemic
surgical patients were without a diagnosis of diabetes at the time of
admission. These patients had a mean peak glucose of 299 mg/dl, and 66
% had two or more elevated values during their hospitalization. Fifty-
four percent received insulin therapy and 59% received bedside glucose
monitoring, yet 66% of daily patient progress notes failed to comment
on the presence of hyperglycemia or diabetes. Diabetes was documented
in only three patients (7.3%) as a possible diagnosis in the daily pr
ogress notes. CONCLUSIONS - Despite marked hyperglycemia, most medical
records made no reference to the possibility of unrecognized diabetes
. Given the average delay of a decade between the onset and diagnosis
of type 2 diabetes, further evaluation of hyperglycemic hospitalized p
atients may present an important opportunity for earlier detection and
the initiation of therapy.